2020-11-11T15:49:37-06:00 2019-12-31 990 2019-01-01 237383042 HENRY FORD HEALTH SYSTEM FOUNDATION HENR 3138768704 ONE FORD PLACE - 5F DETROIT MI 48202 ROBIN DAMSCHRODER EVP FINANCE/CFO 3138768714 2020-11-11 150.198.64.203 2020-11-11 15:36:08 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 4D7818B4378CD12CB7018F8280EB59C545A2623B 2019 2021-01-29 14:40:06Z ROBIN DAMSCHRODER ONE FORD PLACE - 5F DETROIT MI 48202 115725747 0 X N/A X 1974 MI TO IMPROVE LIFE BY SUPPORTING EXCELLENCE IN THE SCIENCE AND ART OF HEALTH CARE AND HEALING. 32 26 0 0 0 0 0 0 0 0 26554945 24456527 8603 16375 26563548 24472902 15606883 16213100 0 0 0 0 0 0 0 1300089 1147862 16906972 17360962 9656576 7111940 307805673 341894595 15600000 16200000 292205673 325694595 X THE HENRY FORD HEALTH SYSTEM FOUNDATION (THE FOUNDATION) IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM (HFHS) SERVING THE METROPOLITAN DETROIT MICHIGAN COMMUNITIES. AS AN INTEGRATED COMPONENT OF ONE OF THE NATION'S LEADING COMPREHENSIVE, INTEGRATED HEALTH SYSTEMS, THE FOUNDATION EXISTS TO ADVANCE THE GOALS AND MISSION OF HFHS AND TO IMPROVE THE QUALITY OF HUMAN LIFE THROUGH ITS SUPPORT OF THE SCIENCE AND ART OF HEALTH CARE AND HEALING. THE ORGANIZATION PROVIDES FINANCING TO VARIOUS RESEARCH AND OTHER INITIATIVES OF HFHS. 0 0 16213403 16213100 20080209 THE FOUNDATION'S PURPOSE IS TO MANAGE AN ENDOWMENT FUND AND BASED ON THE RESULTS OF HFHS NEEDS ANALYSIS, PROVIDE FUNDING TO VARIOUS RESEARCH AND OTHER INITIATIVES OF HFHS AND ITS AFFILIATES. 16213403 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 32 26 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 0 0 0 X ROBIN DAMSCHRODER 3138768714 ONE FORD PLACE DETROIT MI 48202 WRIGHT L LASSITER III TRUSTEE- PRESIDENT 2.00 63.00 X X 0 5262561 54982 WILLIAM A CONWAY MD PHYSICIAN TRUSTEE 1.00 64.00 X 0 1289133 48776 ROBIN S DAMSCHRODER TREASURER 2.00 63.00 X 0 966630 199409 MICHELLE JOHNSON TIDJANI ESQ SECRETARY 2.00 63.00 X 0 910490 157996 HENRY W LIM MD PHYSICIAN TRUSTEE 1.00 60.00 X 0 754242 49444 TAMER A GHANEM MD PHYSICIAN TRUSTEE 1.00 60.00 X 0 427719 51936 CELESTE WILLIAMS MD PHYSICIAN TRUSTEE 1.00 60.00 X 0 444241 32373 MARY JANE VOGT TRUSTEE 1.00 0.00 X 0 371257 37320 EDWARD G CHADWICK FORMER TREASURER 0.00 0.00 X 0 336702 0 MARJORIE A STATEN JD ASSISTANT SECRETARY 1.00 60.00 X 0 166055 13156 WALTER E DOUGLAS TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL E BERGER TRUSTEE 1.00 0.00 X 0 0 0 THOMAS C BUHL TRUSTEE - CHAIR 2.00 0.00 X X 0 0 0 ROBERT C BOBB TRUSTEE 1.00 0.00 X 0 0 0 IAN BURNSTEIN TRUSTEE 1.00 0.00 X 0 0 0 GRETCHEN GONZALES DAVIDSON TRUSTEE 1.00 0.00 X 0 0 0 ALLEN H DEMCHIK TRUSTEE 1.00 0.00 X 0 0 0 TIFFANY SLEMMONS DOUGLAS TRUSTEE 1.00 0.00 X 0 0 0 SHARI E FINSILVER TRUSTEE 1.00 0.00 X 0 0 0 DAVID M HEMPSTEAD TRUSTEE 1.00 4.00 X 0 0 0 NIKOLAOS MOSCHOURIS TRUSTEE 1.00 0.00 X 0 0 0 KATHLEEN J WHELAN TRUSTEE 1.00 0.00 X 0 0 0 BENSON FORD JR TRUSTEE 1.00 0.00 X 0 0 0 PETER D CUMMINGS TRUSTEE 1.00 0.00 X 0 0 0 CALVIN R FORD TRUSTEE 1.00 0.00 X 0 0 0 LINDA HAYMAN TRUSTEE 1.00 0.00 X 0 0 0 JEFFREY TAMAROFF TRUSTEE 1.00 0.00 X 0 0 0 FREDERICK LAVERY TRUSTEE 1.00 0.00 X 0 0 0 KYLE ANNE SASENA TRUSTEE 1.00 0.00 X 0 0 0 WENDY WILLIAMS POWERS TRUSTEE 1.00 0.00 X 0 0 0 VONDA GRANT TRUSTEE 1.00 0.00 X 0 0 0 MATTHEW S SOSIN TRUSTEE 1.00 0.00 X 0 0 0 ANTHONY J VIVIANO TRUSTEE 1.00 0.00 X 0 0 0 RAVINDER T SHAHANI TRUSTEE 1.00 0.00 X 0 0 0 TODD A WYETT TRUSTEE 1.00 0.00 X 0 0 0 LYNN FORD ALANDT TRUSTEE 1.00 4.00 X 0 0 0 0 10929030 645392 0 1 1 0 0 4376318 4376318 111333054 91252845 20080209 20080209 20080209 ROYALTY INCOME 523000 16375 16375 16375 24472902 20080209 0 4392693 16213100 16213100 INVESTMENT FEES 1134347 1134347 ACCOUNTING FEES 13212 13212 TRUSTEE FEES 303 303 17360962 16213403 1147559 0 1612604 1634529 208406608 247286130 97787956 92973964 -1495 -28 307805673 341894595 15600000 16200000 15600000 16200000 X 292205673 325694595 292205673 325694595 307805673 341894595 7111940 26376982 0 X X 0 1 X 1 0 X X 1 HENRY FORD HEALTH SYSTEM 381357020 3 1 16213100 0 1 16213100 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 OTHER SECURITIES 48940790 F HFHS MALPRACTICE 449461 F VENTURE CAPITAL, PARTNER 43583713 F 92973964 X PART X, LINE 2: THE SYSTEM DOES NOT HAVE ANY MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2019 AND 2018. 1 HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT MI 48202 381357020 501(C)(3) 16213100 RESEARCH FUNDING TO HENRY FORD HEALTH SYSTEM RESEARCH FUNDING TO HFII CORPORATION (HENRY FORD INNOVATION INSTITUTE) 1 X X X X 1 1 0 0 0 0 0 0 0 WRIGHT L LASSITER III TRUSTEE- PRESIDENT 0 1621355 0 1423918 0 2217288 0 24119 0 30863 0 5317543 0 1627135 WILLIAM A CONWAY MD PHYSICIAN TRUSTEE 0 725055 0 404174 0 159904 0 26919 0 21857 0 1337909 0 0 ROBIN S DAMSCHRODER TREASURER 0 763585 0 182803 0 20242 0 173712 0 25697 0 1166039 0 0 MICHELLE JOHNSON TIDJANI ESQ SECRETARY 0 634552 0 274228 0 1710 0 132831 0 25165 0 1068486 0 0 HENRY W LIM MD PHYSICIAN TRUSTEE 0 634422 0 93673 0 26147 0 26920 0 22524 0 803686 0 0 TAMER A GHANEM MD PHYSICIAN TRUSTEE 0 333605 0 29210 0 64904 0 24119 0 27817 0 479655 0 0 CELESTE WILLIAMS MD PHYSICIAN TRUSTEE 0 375407 0 42588 0 26246 0 25520 0 6853 0 476614 0 0 MARY JANE VOGT TRUSTEE 0 321873 0 40103 0 9281 0 26919 0 10401 0 408577 0 0 EDWARD G CHADWICK FORMER TREASURER 0 0 0 0 0 336702 0 0 0 0 0 336702 0 0 MARJORIE A STATEN JD ASSISTANT SECRETARY 0 165265 0 0 0 790 0 2941 0 10215 0 179211 0 0 PART I, LINES 4A-B PART 1 LINE 4A: SEVERANCE PAYMENTS MADE BY HENRY FORD HEALTH SYSTEM EDWARD G. CHADWICK (FORMER CFO) $336,702 SCH J, LINE 4B, PERSON PARTICIPATING IN HFHS NONQUALIFIED RETIREMENT PLANS SEC 457(F) - SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) VALUE OF TAXABLE REPORTABLE 2019 ACCRUAL NON VESTED 2019 DISTRIBUTIONS W-2 AMOUNTS PARTICIPANT WILLIAM A. CONWAY,MD 159,904 - - 159,904 WRIGHT L. LASSITER III 2,193,386 - - 2,193,386 MICHELLE JOHNSON TIDJANI - - 109,412 - CONTRIBUTIONS TO SEC 457(B)-NON-QUALIFIED DEFERRED COMPENSATION RETIREMENT PLAN EMPLOYEE EMPLOYER MEDICARE REPORTABLE 2019 CONTRIBUTIONS 2019 CONTRIBUTIONS TAX GROSS-UP W-2 AMOUNTS HENRY W. LIM, M.D. - 19,000 457 19,457 WRIGHT LASSITER III 19,000 - - 19,000 TAMER A. GHANEM, M.D. - 2,330 56 2,386 ROBIN DAMSCHRODER 19,000 - - 19,000 CELESTE THOMAS WILLIAMS 6,624 5,175 125 11,924 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A TAX EXEMPT MEMBERSHIP CORPORATION AND THE SOLE MEMBER OF THE ORGANIZATION IS HENRY FORD HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER OF THE ORGANIZATION, HFHS HOLDS THE RESERVE POWER TO APPROVE OR DISAPPROVE TRUSTEE APPOINTMENTS. FORM 990, PART VI, SECTION A, LINE 7B BASED ON THE ESTABLISHED RESERVE POWERS, CERTAIN DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM (HFHS) AND THE TAX DEPARTMENT OF HFHS PREPARES THE ORGANIZATION'S FORM 990. AS PART OF THE PREPARATION AND REVIEW PROCESS PRIOR TO FILING THE RETURN THE FOLLOWING REVIEW PROCESS IS CONDUCTED: - REVIEW OF THE ENTIRE RETURN WITH THE HFHS SENIOR VICE PRESIDENT, FINANCIAL OPERATIONS AND CHIEF FINANCIAL OFFICER, - REVIEW OF ALL COMPENSATION MATTERS AND DISCLOSURES WITH THE HFHS COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. - REVIEW OF THE RETURN WITH THE HFHS AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS AND CEO AND COO - PROVIDE A COPY OF THE RETURN TO THE HFHS BOARD OF DIRECTORS FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION IS AN AFFILIATE OF HENRY FORD HEALTH SYSTEM (HFHS) WHO OVERSEES THE CONFLICT OF INTEREST PROCESS WITH REGARD TO THE ORGANIZATION. HFHS HAS A STANDING CONFLICT OF INTEREST COMMITTEE (THE COMMITTEE) THAT IS RESPONSIBLE FOR OVERSIGHT OF ALL CONFLICT OF INTEREST MATTERS. THE HFHS CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS AND EMPLOYEES. ANNUALLY, DIRECTORS, EMPLOYEES OF A MANAGEMENT LEVEL, RESEARCHERS, AS WELL AS EMPLOYEES ASSOCIATED WITH PROCUREMENT, OR IN CERTAIN OTHER PREDEFINED ROLES MUST COMPLETE AN ANNUAL DISCLOSURE DESIGNED TO IDENTIFY ACTIVITIES AND RELATIONSHIPS THAT COULD POTENTIALLY GIVE RISE TO A CONFLICT OF INTEREST. IT IS THE RESPONSIBILITY OF THE COMMITTEE TO REVIEW THESE DISCLOSURES AND DETERMINE THE NEED FOR ANY ACTION TO MANAGE THE POTENTIAL CONFLICT. THE COMMITTEE ANNUALLY REPORTS THE RESULTS OF ITS ACTIVITIES TO THE HFHS AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 IT IS THE PRACTICE OF THE ORGANIZATION TO MAKE ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO ANY PARTY REQUESTING SUCH INFORMATION. FORM 990, PART IV, LINE 12 THE ORGANIZATION IS AN ELEMENT OF THE EXTERNAL AUDIT REPORT OBTAINED FOR THE CONSOLIDATED OPERATIONS OF HENRY FORD HEALTH SYSTEM. FORM 990, PART XII - LINE 2C HENRY FORD FOUNDATION (FUND) IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF HENRY FORD HEALTH SYSTEM. THE GOVERNING BODY OF HFHS HAS DELEGATED THE OVERSIGHT OF THE FINANCIAL STATEMENTS, INCLUDING THE CHOICE OF INDEPENDENT AUDITORS, TO ITS AUDIT COMMITTEE. FORM 5713 - INTERNATIONAL BOYCOTT ACTIVITY: A FORM 5713, INTERNATIONAL BOYCOTT REPORT, HAS BEEN FILED ON OUR BEHALF BY HENRY FORD HEALTH SYSTEM (PARENT OF OUR CONTROLLED GROUP OF WHICH THE ORGANIZATION IS A MEMBER). THE ORGANIZATION DID NOT ITSELF HAVE ANY ACTIVITIES ASSOCIATED WITH AN INTERNATIONAL BOYCOTT COUNTRY. HENRY FORD HEALTH SYSTEM ONE FORD PLACE DETROIT MI 48202 381357020 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 N/A 0 HENRY FORD WYANDOTTE HOSPITAL 2333 BIDDLE AVE WYANDOTTE MI 48192 382791823 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 HENRY FORD HEALTH SYSTEM 1 HEALTH ALLIANCE PLAN 2850 W GRAND BLVD DETROIT MI 48202 382242827 HEALTH MAINTENANCE ORGANIZATION MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 HFII CORPORATION ONE FORD PLACE DETROIT MI 48202 900840304 SCIENTIFIC RESEARCH MI 501(C)(3) LINE 7 HENRY FORD HEALTH SYSTEM 1 HENRY FORD HEALTH SYSTEM GOVERNMENT AFFAIRS SERVICES ONE FORD PLACE DETROIT MI 48202 464064067 ADVOCACY SERVICES FOR HFHS AND AFFILIATES MI 501(C)(4) N/A HENRY FORD HEALTH SYSTEM 1 HENRY FORD MACOMB HOSPITAL CORPORATION ONE FORD PLACE DETROIT MI 48192 382947657 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 HENRY FORD HEALTH SYSTEM 1 HENRY FORD ALLEGIANCE HEALTH GROUP 205 N EAST AVENUE JACKSON MI 49201 382756428 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 12B, II HENRY FORD HEALTH SYSTEM 1 ALLEGIANCE HEALTH FOUNDATION 205 N EAST AVENUE JACKSON MI 49201 383607833 SUPPORT ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD ALLEGIANCE HEALTH GROUP 1 HOSPICE OF JACKSON DBA ALLEGIANCE HOSPICE 205 N EAST AVENUE JACKSON MI 49201 382336367 HOSPICE MI 501(C)(3) LINE 7 HEALTHLINK 1 HEALTHLINK 205 N EAST AVENUE JACKSON MI 49201 382756425 HOME HEALTH CARE MI 501(C)(3) LINE 12A, I HENRY FORD ALLEGIANCE HEALTH GROUP 1 CARELINK OF JACKSON 110 NORTH ELM AVENUE JACKSON MI 49202 381218485 LONG TERM ACUTE HOSPITAL MI 501(C)(3) LINE 3 HENRY FORD ALLEGIANCE HEALTH GROUP 1 WA FOOTE MEMORIAL HOSPITAL DBA HENRY FORD ALLEGIANCE HEALTH 205 N EAST AVENUE JACKSON MI 48201 382027689 HEALTHCARE SERVICE PROVIDER MI 501(C)(3) LINE 3 HENRY FORD ALLEGIANCE HEALTH GROUP 1 THE CLARENCE S LIVINGOOD LECTURESHIP AND EDUCATION FUND 3031 WEST GRAND BOULEVARD NO 800 DETROIT MI 48202 382682321 SUPPORT ORGANIZATION MI 501(C)(3) LINE 12B, II HENRY FORD HEALTH SYSTEM 1 NORTHWEST DETROIT DIALYSIS 30100 TELEGRAPH BINGHAM FARMS MI 48025 383232668 OPERATE DIALYSIS CLINIC MI HENRY FORD HEALTH SYSTEM N/A 0 0 MACOMB REGIONAL DIALYSIS CENTERS 16151 NINETEEN MILE RD CLINTON TOWNSHIP MI 48038 260423581 OPERATE DIALYSIS CLINIC MI HENRY FORD HEALTH SYSTEM N/A 0 0 FOOTE HEALTH CENTER ASSOCIATES 1100 E MICHIGAN AVENUE JACKSON MI 49201 383017711 LESSOR OF MEDICAL CONDOMINIUM MI HENRY FORD ALLEGIANCE HEALTH GROUP RELATED 0 0 SHA REALTY INC ONE FORD PLACE DETROIT MI 48202 381378121 REAL ESTATE HOLDING MI HENRY FORD HEALTH SYSTEM FOUNDATION C 490007 6820509 1.00000 1 FAIRLANE HEALTH SERVICES 30100 TELEGRAPH BINGHAM FARMS MI 48025 382565235 HEALTHCARE MANAGEMENT MI HENRY FORD HEALTH SYSTEM C 1 ALLIANCE HEALTH AND LIFE INSURANCE 2850 W GRAND BLVD DETROIT MI 48202 383291563 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HAP PREFERRED INC 2850 W GRAND BLVD DETROIT MI 48202 382513504 PROVIDER NETWORK LEASING MI HEALTH ALLIANCE PLAN C 1 ONIKA INSURANCE LTD FIRST CARRIBEAN HOUSE GRAND CAYMAN CAYMAN ISLANDS CJ CAPTIVE INSURANCE CJ HENRY FORD HEALTH SYSTEM C 1 HENRY FORD PHYSICIAN NETWORK ONE FORD PLACE DETROIT MI 48202 320306774 PHYSICIAN NETWORK MI HENRY FORD HEALTH SYSTEM C 1 ADMINISTRATION SYSTEMS RESEARCH CORPORATION 2850 W GRAND BLVD DETROIT MI 48202 382651185 THIRD PARTY INSURANCE ADMINISTRATOR MI HEALTH ALLIANCE PLAN C 1 HAP EMPOWERED HEALTH PLAN INC 2850 W GRAND BLVD DETROIT MI 48202 383123777 HEALTH INSURANCE PROVIDER MI HEALTH ALLIANCE PLAN C 1 HENRY FORD ALLEGIANCE PHARMACY 205 N EAST AVENUE JACKSON MI 49201 383370242 PHARMACY MI HENRY FORD ALLEGIANCE HEALTH GROUP C 1 HENRY FORD ELIJAH MCCOY CONDOMINIUM ASSOCIATION 1150 ELIJAH MCCOY DR DETROIT MI 48202 852144748 CONDOMINIUM ASSOCIATION MI HENRY FORD HEALTH SYSTEM S 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 HENRY FORD HEALTH SYSTEM B 16213100 CASH VALUE SCHEDULE R, PART V, LINE 1D & 1E: THE ORGANIZATION, AS A DESIGNATED AFFILIATE, IS A MEMBER OF THE HENRY FORD HEALTH SYSTEM CREDIT GROUP. MEMBERS OF THE CREDIT GROUP ARE JOINTLY AND SEVERALLY LIABLE FOR OUTSTANDING OBLIGATIONS ISSUED UNDER THE 2016 HFHS BOND MASTER INDENTURE.